by Douglas Walter
ealth care, whether directly or indirectly working with patients, is a team effort, said Donna Nielsen, a registered nurse who heads performance improvement and risk management at the Gunnison Valley Hospital.
And when Nielsen retires this month from a nursing career that stretches across five decades, which has put her in numerous nursing roles, it’s that team effort that she’ll miss the most.
"I think for anyone who leaves a position, it’s leaving the people who you admire and respect," Nielsen said. "In health care, you always work in a team, and I’ll miss that teamwork."
Nielsen’s final role has been working in performance improvement and risk management at Gunnison Valley Hospital, which she has done for seven years. She works in teams to identify ways hospital staff can more effectively serve patients, while keeping the hospital safe from possible lawsuits.
It’s a logical field for Nielsen to end her nursing career in, as it touches on all the skills she’s developed over the years as a nurse, nurse instructor and administrator.
She graduated from Montanan State University in 1959 and immediately went into nurse instruction. From there, she has worked in numerous position, such as a pediatric nurse in Missoula, Mont., director of nursing in Gunnison, public health nursing, education director for Solomon Health Care and director of clinical services at Montrose Hospital, just to name a few of her positions.
Along the way, she somehow managed to get a masters degree from the University of Colorado while working 50 hour weeks.
Nielsen sees her experience over the years equally touching three practices: patient care, education and administration, all of which comes into play when thinking about performance improvement and risk management.
Though the position isn’t primarily designed for nurses, Nielsen said it’s appropriate for nurses to be sought after for the job because of their integral roles in providing health care.
"They are the liaison, the critical person on the health care team," she said.
She said nurses have a unique understanding of health care, such as 24-hours of hospital care and treating the whole patient, including psychological and social aspects. This perspective is important when identifying problems and finding feasible solutions.
Interestingly enough, the practice of performance improvement, in general, can be traced to Japanese automakers, Nielsen said.
During the 1980s, the Japanese studied American car companies to find ways to make better cars for less money. The result was the Japanese’s car markers eventually outselling the Americans car market. That then kick started similar performance improvement models in several industries, including health care.
"This is now a huge field, not only in health care, but in several industries," Nielsen said.
But health care was one of the first industries to buy into performance improvement and then risk management, after the Japanese success in auto making. It happens as large health care companies began to merge and began looking at ways to improve their services.Initially, reducing wait times in emergency room was the primary area studied, Nielsen said.
But today, the practice spans into every area of the hospital, including administration and billing. The goal is to identify waste, such as a waste of time and resources, and then work with staff to eliminate that waste.
"Obviously, the idea is to have everyone (in the hospital) understand the basic principles," Nielsen said of performance improvement and risk management.
Staff can also report basic problems that arise in serving patients or situations that have unexpected outcomes.
A few years ago, for example, Gunnison County began seeing more and more Spanish-only speaking residents, due to an influx of agricultural work and seasonal jobs at nearby Crested Butte Ski Area. Nursing and other medical staff couldn’t communicate with patients who came to the hospital, which became an issue of performance improvement and risk management.
The implications of the situation are serious, Nielsen said. Staff that can’t understand a patient, also won’t fully know the extent of a patient’s symptoms. The patient can’t be properly diagnosed and treated, putting a hospital out of compliance.
"We put together a group that we called the language barrier group," Nielsen said of finding a solution.
The group initially hired a telephone translating service to help communicate with patients to solve the problem. But other issues arose as staff started using the service, because they were passing a phone back and forth.
"Although it was an excellent service, it wasn’t very user friendly," Nielsen said.
At the same time, county officials created the Gunnison County Multi-Cultural Office, which, among other things, had identified people throughout the region who could be used as translators. The hospital seized this opportunity and forged an agreement with the county to hire the translators at the hospital when they are needed.
"That agreement still exists today," Nielsen said.
Nielsen admitted that, when she retires, she’ll miss this type of problem solving through team work. Though, she’s also looking forward to some time off to travel. Still, there’s always a new opportunity for good nurses, and she only laughed when asked if she truly believed a good nurse really ever fully retires.
"We’ll see what opportunities come up, and we’ll see what the next door is that opens," she said.